LITMIR.BIZ

Скачать книгу

of Douglas Ore, Tom Elfwood and Robert Ellis as possible consultants to this end.

      Mr. Scialabba is a 38-year-old Harvard employee, who comes to me for a referral for ongoing therapy. He’s a graduate of Harvard College, class of ’69, has had a fair amount of treatment with a variety of therapists in the past, including having been seen by a number of people in the UHS, although that record was not available to me today. He recognizes that he is stalemated in his life and his career and that it’s emotional problems that are blocking him from taking next developmental step. He wants to definitively go to work on these problems. Though he’s seen many therapists in the past and has made some progress with some and with others considered the experience worthless, he has never been able to grow in the way he clearly needs to do if he’s going to move beyond his current position. By that he means that he has considerable intellectual capability, was originally planning to go into a religious order but split off from that when he was in college, did begin graduate school at Columbia but was in so much emotional turmoil and was unable to concentrate that even that came to an end after a year. Since that time he has had a variety of low-level jobs and although he functions adequately in them, he is certainly not living up to his intellectual potential at all. This is also true in his personal life, he lives alone, he has some friends, but he only allows people to get so close to him. His best friend is an old one from the past but one who lives in New York, and I gather the friendship is expressed mostly by letter. There have been many women in his life but the relationships have always been short-lived, and when he begins to sense that the woman wants to go further with the relationship, he begins to find things that are wrong and creates such distance that the relationship breaks off.

      April 13, 1987

      Grace Franklin, MD/MTL

      In case he changes his mind about ongoing therapy, I gave him Margaret Williams’s name. Her clinic might be able to offer him a reduced fee for therapy that would be manageable for him.

       Intermittently Hopeless (1987–1988)

      July 6, 1987

      Melinda R. Maron

      McLean Hospital, Ambulatory Care Services

       Intake Report

      Chief Complaint:

      Patient saw Dr. Mason once. Referred him here because of financial concerns. Feels emotionally fragile, high-strung, unable to make life decisions. Feels he’s drifting professionally. “Ridiculously over-qualified for what he does.”

      History of Present Problem:

      Early traumatic break from religious tradition, Catholicism, at age 21 from which he’s never really recovered.

      Family Information/Current Living Situation:

      Lives alone. Parents and one brother live in the area.

      Medical History/Current Medications:

      Physically in good health, though not “bursting with energy.”

      No meds, alcohol or drugs.

      Previous Outpatient Treatment:

      Yes—few times in the ’70s.

      Previous Hospitalizations:

      None.

      Additional Psychiatric History:

      One cousin had psych problems and suicide at age 22.

      Insurance Coverage:

      Harvard University Group Health Plan (HUGHP)

      Impression at Intake:

      Patient found it difficult to talk, seemed very constricted and upset.

      August 25, 1987

      Juan Durendal, MD

      McLean Hospital, Ambulatory Care Services

      S. I was feeling really down when I called you.

      O. Anxious, mildly depressed, ruminative.

      A. Given history of anxiety with prominent somatic components, depression, following relatively minor negative events, n/o phobias, an MAOI seems indicated. Patient aware of risks and benefits of trial, understands possibility of HTN [hypertensive response] if not following diet. Aware of the need for concomitant psychotherapy, agrees to see Melinda Maron weekly.

      P. 1) Start Parnate 10 mg po. Follow-up in a week.

      August 25, 1987

      Juan Durendal

      S. I’m intermittently hopeless.

      O. Very tense, restless, sighing, unchanged from previous meetings.

      Patient had to turn down a teaching job offered to him by a friend because of overwhelming anxiety, fear of failure or “crack-up.” Felt better after turning it down but became somewhat hopeless. No side effects from Parnate.

      Increase Parnate to 20 mg. Follow-up in a week.

      September 9, 1987

      Juan Durendal

      S. Feeling the same, sleeping more or less okay.

      O. Tense, anxious still ruminating about giving up the opportunity to teach history because of his anxiety.

      A/P. Tolerating increasing doses of Parnate, no side-effects prominent.

      Increase Parnate to 30 mg po AM. Follow-up in a week.

      September 23, 1987

      Juan Durendal

      S. I’ve been having some orthostatic hypotension, my mood is as usual.

      Constricted, anxious affect. Sleeping well, waking up once during the night as is usual for him, well rested in the morning. Patient is interested in shifting his sleeping pattern from sleeping between 2:00 a.m.—10:00 a.m. to something like 12:00 midnight—7:00 a.m. to be able to have a more socially active life, prepare papers for courses, etc.

      A. Tolerating Parnate 40 mg d, some orthostatic hypotension, some increased energy. Finds therapy to be beneficial “at least I have someone intelligent to talk to.” Will attempt shifting his s/a cycle over the next 2–3 wks. Patient given instructions regarding hygienic measures to improve sleep. Will discuss starting cognitive Rx.

      P. Continue Parnate 40 mg Halcion 0.123 mg for insomnia.

      December 3, 1987

      Melinda R. Maron

      Met with Mr. Scialabba for 50 minutes. Focus of session was his difficulties in relationships; feeling either intimidated and unequal or feeling superior and condescending. Pattern is to avoid all relationships. Lately, however, is making attempts to socialize.

      December 10, 1987

      Melinda R. Maron

      Said that for him the pursuit of pleasure and self-expression seems to be confused with anger. Said a woman in a psychotherapy group once described him as a “ticking bomb.” He feels that in some way this is true. Is afraid of his angry impulses. Feels he has to “pay his dues” by paying attention to politics and taking moral stands. Worries he left Opus Dei for pursuit of pleasure rather than on principle. Very conflicted regarding both pleasure and regression.

      December 17, 1987

      Melinda R. Maron

      Patient talked about his difficulty with intimate relationships. Feels he can only succeed with young, naïve women, who won’t perceive his failings. A “mature” relationship with a “mature” woman is something he avoids. Mr. S seems to worry about every aspect of relationships. Also ambivalent about gratifying his more “superficial” impulses.

      December 24, 1987

      Melinda R. Maron

      Patient reports some old obsessions coming back now. He is again envious of friends and feeling inferior to them. Described his wish to be a reclusive mouse of an academic who would bury himself

Скачать книгу